PathologyII Systemspathology

PATHOLOGYOFPERITONEALCAVITY

The peritoneum is the serous membrane that lines the abdominal cavity and covers all visceral organs. It consists of two layers mesothelium and submesothelial connective tissue. Normal peritoneum is a smooth, shiny membranethatissemipermeabletothemovementofwaterandsmallsolutemolecules. Postmortemexaminationofperitonealcavity Look for displacements, abnormal amount of fluid (ascites), exudates, fat deposits (mesenteric, omental, retroperitoneal,pelvicandperirenal),serosalirregularities(tumor,granulomas,etc) Trauma to abdominal cavity herniation of viscera (scrotum, perineum, diaphragm, eventration); ruptureofliver,spleeninternalhemorrhage ***Notethatfluidaccumulatesintheperitonealcavityafterdeathandbecomesstainedwithhemoglobin. Diffusion of bile pigments through the wall of the gall bladder, the bile ducts, or the duodenum will also stainadjacentviscera*** Anomalies Congenitalpleuroperitonealdiaphragmatichernias Mostcommonlyindogs Defectintheleftdorsalquadrantofthediaphragm Peritoneopericardialdiaphragmatichernias Morecommonthanpleuroperitonealherniasinsmallanimals Oftenclinicallysilent Hernias Abnormalopeningsintheabdominalwallthatpermitpassageoftheabdominalcontents Congenitaloracquired o AcquireddiaphragmaticherniaUsuallyasequeltotrauma o Anyoftheabdominalvisceramayherniateintothethorax,butliverandsmallboweldosomost commonly Abnormalcontentsintheperitonealcavity UroperitoneumPresenceofurineintheperitonealcavityruptureoftheurinarybladder Pneumoperitoneum Presence of air in the peritoneal cavity arises commonly from perforation of the abdominal wall due to traumatic incidents, from concurrent pneumothorax and diaphragmatic tears, orfromleakageofgasandliquidcontentsfromperforationsofthegastrointestinaltract

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HemoperitoneumPresenceofbloodintheperitonealcavitymostcommonlyinthedogandcatasa result of traumatic injury to the liver, spleen, and kidney, and in dogs is also associated with hemangiosarcomasofliverandspleen Ascites (hydroperitoneum) Presence of excess fluid, usually a modified transudate, in the peritoneal cavity(asciticfluidisgenerallywatery,clearorstrawcolored) Ingesta Presence of ingesta in the peritoneal cavityperforation or rupture of the stomach or intestine Peritonitis

Damagetotheserosaoftheperitonealliningassociatedwithinflammation Peritonitis may be classified as primary or secondary; as acute or chronic; as local or diffuse; as septic or nonseptic; and on the basis of the type of exudate, which may be serofibrinous, fibrinopurulent, purulent,hemorrhagic,orgranulomatous

Causes Chemicalperitonitismaybeinducedbyavarietyofagents: o Bileandpancreaticenzymes,talc,otherirritantagents Biliaryperitonitisisrecognizedbythetypicalyellowgreenstaining Peritonitisofpancreaticnecrosisisliquefactiveandpurulent Bacterialperitonitis o Usuallyasaresultofperforatinglesions(gastrointestinalorurogenitaltract,orfromtheskin) o Extension from inflammation localized in an abdominal organ, or as a typical part of the syndromeinanumberofspecificbacteremicdiseases Viralperitonitis o Seefelineinfectiousperitonitis Peritonitisinhorses Rhodococcusequiinfectionoffoals Actinobacillusequulifibrinousmesentericlymphangitisandperitonitis Clostridiumperfringensinfoals,andanthraxinolderhorsesacutehemorrhagicenteritiswithperitonitis Nocardiosis Peritonitisinruminants Perforationoftheabomasum,reticulumoruterus Traumaticreticuloperitonitis("hardwaredisease") Extensionofinfectionfromtheumbilicusoftheneonate Fibrinous peritonitis expression of polyserositis in neonatal calves with septicemic colibacillosis and neonatalstreptococcalinfection Peritonitisinswine Recognizedaspartofthepathologicalpictureinseveraldefinedinfectioussyndromesinpigs Serofibrinous peritonitis, with fibrinous arthritis and exudation on other serous surfacesGlasser's disease(Haemophilusparasuis) Mycoplasmahyorhinisandpossiblyothermycoplasmasserofibrinousperitonitis

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Peritonitisindogs Fibrinohemorrhagicperitonitisiscommonininfectiouscaninehepatitisandtoxoplasmosis Septic peritonitis E. coli and anaerobes, may follow surgical contamination of the abdomen; a penetrating wound or perforation of the gut; rupture of the urinary bladder; or rupture of pancreatic, hepaticorprostaticabscesses PyogranulomatousperitonitisNocardiaasteroides Peritonitisincats Felineinfectiousperitonitis(FIP) Worldwide, invariably fatal, sporadic, low prevalence viral disease of domestic and wild felids caused by felinecoronavirus(FCoV) Generally, most affected cats are less than 3 years of age and live in multiplecat situations (shelters, breeding catteries) purebred domestic cats and certain species of large cats (e.g. cheetahs) may be geneticallypredisposedtodevelopingFIP There are twostrains of FCoV: feline infectious peritonitis virus (FIPV) and feline entericvirus coronavirus (FECVsee gastrointestinal system notes) It is reported that FIPV is a mutation of FECV that has acquired macrophage tropism FIPV infects and replicates primarily in macrophages, resulting in systemicinfection There are three clinical forms of FIP: effusive (wet), noneffusive (dry), and a form combining features of both o If strong cellmediated immune responsemacrophages activated FIPV replication terminatednodisease o If weak cellmediated immune response FIPV persists in macrophages more prolonged courseofdiseaseperivascularpyogranulomasinparenchymatousorgans(noneffusiveform) o If no cellmediated immune response continuous virus replication short clinical course deathin112weeksvasculitisproteinrichpleuralandperitonealeffusion(effusiveform) Effusive form depression, inappetence, weight loss, dyspnea, tachypnea, and thoracic and/or abdominal effusion(ascites) o Abdominal and thoracic organs covered with small (12 mm) white plaques of fibrin with a granularappearance;largeamountsoffibrinadhesionsonvisceralandperitonealsurfaces Noneffusive form weight loss, fever, depression, and signs specific to particular organs affected by vascular lesions(e.g.oculardisease,centralnervousdisorders,renalfailure,hepaticorpancreaticinsufficiency) o Granulomasinvariousorgans(onsurfaceandthroughout) o Thickened colon , lymphadenopathy, pyogranulomas; hydrocephalus in cats with neurologic involvement, hypopyon (leukocytic exudate in the anterior chamber), hyphema (blood in the anteriorchamber),cornealedema Thoughoftendescribedasdistinctentities,thewetanddryformsofFIParetheextremesofacontinuumof syndromeswithvasculitisandpyogranulomatousinflammationasthehallmarks Neoplasticdiseasesoftheperitoneum Mesotheliomas Rare; occur with greatest frequency in cattle and dogs but are reported in horses, cats, pigs, and other species(humansasbestosexposure) Arisefromthecellsoftheserousliningsofpericardial,pleuralandperitonealcavities

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Lipomas Most common tumors (benign) of the peritoneal interstitium horses (originate in the mesenteries) becomepedunculatedandmaycauseacutestrangulation References Pathology of Domestic Animals, eds. Jubb KVF, Kennedy PC, Palmer NC, 5th ed. Elsevier, Philadelphia, PA, 2007 TumorsinDomesticAnimals,ed.MeutenDJ,4thed.IowaStatePress,Ames,IA,2002

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